Αιτιώδεις διεπιδράσεις από τις διαφορετικές δομικές διαρθρώσεις του Εαυτού σε εκδοχές της σύνολης υγείας: συγχρονική κλινική ψυχολογική διερεύνηση για φοιτητικό πληθυσμό

Abstract

Although utmost tribute is here paid to the early, almost atavistic, Maddian triad of: Control-Challenge-Commitment, which is unwaveringly assumed to form only one of the many illusory aspects of the, anyway elusive, personality, i.e., the aspect of Psychological Hardiness, however, the present work introduces an unprecedented, expansive perspective, and maintains that: (i) the ever-persistent, pervasive volatility of statistical reliability in the various germane measures producing fuzzy outcomes from one sample to another; and (ii) the various factual obstacles to its long-delayed worthy integration into mainstream clinical Praxis, are both impediments, that ultimately result from the unchanged, only marginally reconsidered or re-evaluated, uniform reproduction of the reiterated conception of its very components, throughout its history, research and therapeutic experimentations. Enmeshed in these comes also the dual methodological habituation hindrance of (i) hastily taking samples as indiscriminate wholes and (ii) hurriedly classifying their profiles either by high medium-low hardy-scores or by further fragmentation (e.g., high-medium vs low-medium), after only aggregating gauges upon collecting data from relevant measures. This study adopts the Palaiologean distillation, from the corresponding reconceptualized attributes typology of the new triad, emerging through longitudinal bottom-to-top R&D, i.e., the Control-Capture-Conduct triad (in courteous retaining of the Maddian 3Cs acronym), surfacing as the 3 (of the now 4) primary fundamental subsystems which, according to this novel view, are decisively shaped by their superior entity, the Self. Hence, Hardiness is revealed as the special interface and as the codification messenger of the Self to the Person who selectively embodies the potency of the Self, and thus Hardiness constitutes a distinctive internal, personal "language", conveying strategy messages for preferred health types. Also, the study follows the methodological canon of the Self, which despite being coded, is found discernible in the conveyed optimal psychobiosocial whole-health types, while nevertheless, Persons, often spontaneously, establish Differential Delimitations of his newly understood triad, as expressed according to their subjective Personal Progress Priorities, for a not always obvious healthiness. The six, known as most commonly formed of these Differential Delimitations, were identified and studied via a battery of psychobiosocial health measures, counting a total of 154 variables from 14 self-report questionnaires, administered to a randomly selected sample of N = 231 consenting research participants, who originated from a multitude of urban, suburban and rural environments and were officially registered attendees at the Universities of Ioannina and Athens. Participants completed the battery in 3 parts, within a 3-week per person timespan, and were compared on the basis of (i) their undergraduate-vs-postgraduate study level, (ii) their gender and ultimately (iii) their subgroups in line of their DDs of the Self, during a correlational, cross-sectional comparative causative study project, launched as a partial fulfilment for the author’s doctoral thesis. Besides demographic checklists, the measures explored a comprehensive whole of what is here perceived as health facets, pertaining to self-governance in its broadest possible sense: daily hassles (WOC-R); work zest (UWES); relational proximity (ECRI-R); EI-conscientiousness (WEIS); intellectual coherence (SOC); spirituality planes (SWBS); ideas of the beyond (DAP-R); health viewpoints (RHHI); health epicenter (HLC); recollections of upbringing experiences (EMBU-PER); quality of life (WHOQOL); potential signs of clinical-psychological disturbances (SA-45); likely clinical-psychological turmoil intensifiers (DASS-21); and, certainly, the Specs of the Self per se (MPPPI-NHS); along with a detailed medical record extract from a hospital pre-admission assessment tool on the history of participants’ possible psychophysical health nuisances as well as a set of open and close-ended items on participants’ subjective evaluation of quality of health. If each of the six Differential Delineations, vis-à-vis all variables involved, conceptually confirmed its distinctive features, and amounted to corresponding functionable predictive models of personalized Strategies about Whole-Health priorities, then suggestions could be uttered on the usefulness of this innovative typology for the envisaged prospects it entails for research, theory, and advanced therapeutic applications alike. Furthermore, through treating the individual scores on Personal Progress Priorities in accordance with the methodological canon of the Self as the composer of his, afresh understood, basic trinity from his (so far four known) subsystems, bearing in mind that the latter are rearranged by interpolation of the Person's preferences, and thus achieving the analogous subgrouping of the sample already at the outset in harmony with those inherent Differential Delineations of its members (i.e., non-taking the aggregation of the sample scores as merely some numerical succession of a supposedly unified, undifferentiated group), it was expected that the statistical stability would be regained within the scoring-range of each one of the six personalized triads emerging (ultimately, might they be measured by any means), as this would transpire, at last, due to the long-hoped-for typological specifications dictated by the Persons themselves rather than due to the usual retrospective psychometric focus on the reprocessing of tools and data, mainly for redrafting/rephrasing, reforming and/or repairing the various related measures. Upkeep of the Cronbach’s alpha’s stability being a first encouraging step would not only restore confidence in the new trinity, indeed, as a trilogy of subsystems of the superordinate Self, but also strengthen the dual innovative rationale formulated here, based on the results obtained, markedly submitting:: a. the feasibility, sustainability and cost-effectiveness of the shift from traditional Paradigms of Clinical Treatment to the operative prioritization of the, now tangible, measurable and functional Specifications of the Self, as manifested through the Personal Progress Priorities that Persons selectively set for their subjective, yet decisive, particular forms of health that they pursue; and b. the high potential of at least the six predictive models identified here, in order to fulfill to a maximum extent the ever-pressing contemporary demand for satisfying the necessity of reaching fresh insights into the complex health-vs-pathology psychobiosocial conditions, also encompassing the wider objective of early demarcating and timely tackling subclinical indicants –thence (i) to potently serve prevention purposes while also (ii) ensuring concrete therapeutic results by employing multidimensional, interwoven with personalization methodologies. Descriptives aside, correlational-, factorial-, cluster-, regression-, and ROC-curve estimation analyses were sequentially used, along with neural network modelling and transition probability matrixes – all, confirming 22 of the 25 research hypotheses, and fully providing statistically high significant support to all expectations of the study. Correlations attested to the significant meaningfulness of the six secerned types of the Persons, thus warranting a functional typology, whilst all six Differential Delimitations were found to significantly predict the differential Health conditions of the sample subgroups. Construed Nosology Profiles for each of the six identified types, as juxtaposed to participants’ subjective Whole-Health assessments, tentatively indicated that while most participants evaluated highly positively their overall health conditions, almost regardless of the health problems they reported, while their being sub-grouped under each specific Differential Delineation revealed interesting inter-group differences, consistent with their respective psychological profile under the canon of the Self, thus demonstrating the underlying differential Whole-Health Strategies that each subgroup pursued. These findings should readily radicalise therapeutic thinking and interventions, plus drastically open new avenues towards a deeper understanding of, e.g., differential personalized patterns of compliance with (psycho)therapeutic recommendations, and/or differential personalized health rehabilitation pathways. Results are critically discussed for their clinical importance, implications and impact on theory, practice, research, and subsequent policy reforms, if experts are to enhance clinical psychobiosocial counselling tactics and techniques, strategies for consolidative trajectories of psychotherapeutic Praxis, psycho-educational interventions efficiency, and research evolutions – because indications derived from here are already substantial enough to attract attention, and inform scientific fields for the long-awaited modification of framework. Specifically, multidisciplinary palpable benefits can be offered to: (i) epistemology, to challenge established, and re-establish benchmarks for the revealed Self, orienting towards a ‘metacognitional’, post-post-positivist era; (ii) proactive psychoeducation, to change its reference points along its psychobiosocial axis, by foreshadowing vital Differential Delineations in individual profiles, and thus to aid Persons on their own terms, and regardless of their health status; (iii) psychomedical interventions, to strengthen the implementation of improved stratagems, ranging from screening, assessment, diagnoses, case-formulation processes and treatment-planning to reliably evidence-based, and increasingly unbiased care; (iv) methodologies in research engineering, to minimize threshold errors of sampling, subgrouping criteria, and data ranking/classification and elaboration/interpretation, beginning afresh by reconceptualising hardiness/resilience under the canon of the Self; (v) the very expertise on hardiness, resilience, toughness, etc., to reconsider meanings-and-means of accessing core cognitive beliefs, schemas, and scenarios; (vi) agenda-setting processes in psychometry and clinical therapy alike, to ameliorate their transformative plans on novel grounds, by achieving to harness genuine outcomes, directly from the Self, thereby maximising the advantages of identifying Differential Delineations as cornerstones for the expansion of pioneering applications at organizational-institutional level as well; (vii) mental- and physical-health professionals, academicians and trainees/learners, to exploit Differential Delineations of the Self and thus clarify both causal and contextual factors which are both malleable and predictable for maximum scope for change precisely because of the Self, and consequently reorient themselves to develop, own, refine and operationalize the proper personalized ‘language’ as generated directly from the depths of the Self, towards creating more meaningful therapeutic discourse, empowering Individuals and contributing decisively to cost-effective use of services. Keywords: Self, Control, Capture, Contract, Differential Designation Delineations, Personal Progress Priorities, Whole-Health, Self-Management, psycho-educational Praxis.

Ανταποκρινόμενη στις σύγχρονες απαιτήσεις κλινικής αναγκαιότητας για νέα επιστημολογικά παραδείγματα, που να πληρούν κριτήρια πολυπαραμετρικότητας και εξατομίκευσης στις προσεγγίσεις της Σύνολης Υγείας, η διδακτορική αυτή συγχρονική αιτιώδης-συγκριτική συσχετιστική έρευνα συνεξέτασε σε φοιτητικό δείγμα Ν=231 Προσώπων προπτυχιακού-vs-μεταπτυχιακού επιπέδου: α) εμβέλεια αυτοδιαχείρισης σε συνήθεις συνθήκες διαγωγής β) άνεση κατά τις διανθρώπινες επαφές τους και τις αναμνήσεις της ανατροφής τους γ) ενδόμυχη συνοχή δ) συνιστώσες πνευματικότητάς τους ε) θεωρήσεις και πραγματική εμπειρία τους περί την ψυχοφυσική τους υγεία vis-à-vis νόσου, στ) ενδεχόμενες κλινικές/υποκλινικές ψυχολογικές επισφάλειες συν πιθανές στρεσσογόνες και αγχογόνες επιτάσεις αυτών –παράμετροι, ιδωμένες μέσα από τον κανόνα που θέτει ο Εαυτός δομώντας τρεις διακεκριμένες του Οντότητες, Έλεγχο-Έλξη-Ευθύνη, μα δικαιοδοτώντας το Πρόσωπο-φορέα του να τις (ανα)διαρθρώνει με διαφορικές του διαθέσεις, διαμορφώνοντας κατά το δοκούν τη διαλειτουργικότητά τους και, επομένως, συναρμόζοντας σύστοιχες στρατηγικές ψυχοφυσικής υγείας του. Αποσκοπώντας πρωτίστως να εξετάσει εύρος επιδράσεων-επιρροών καθεμίας από τις έξι κύριες διαφορικές δομικές διαρθρώσεις, που διενεργούν τα Πρόσωπα καθώς βιώνουν την εαυτοδομή τους κατά τις ιεραρχικές τους προτιμήσεις, διαπλάθοντας έτσι τα διακριτά προφίλ τους ιδιογραφικής υγείας, η μελέτη αισιοδοξούσε να εκπληρώσει την ύπατη πρόθεσή της, που ήταν να επαληθεύσει προβλεπτική σπουδαιότητα των προφίλ αυτών ως προτύπων, ώστε περαιτέρω να εξυπηρετήσουν σε πρόσφορες αναπλαισιώσεις κλινικών αλλά και (ψυχο)εκπαιδευτικών πρακτικών διευρυμένης απόδοσης κατά την προσπέλαση στις ένδειες των Προσώπων. Κατόπιν επεξεργασίας των δεδομένων διαδοχικά, με μεθόδους Περιγραφικής (Συχνότητες, Ποσοστώσεις, Διαγράμματα), και Επαγωγικής Στατιστικής Ανάλυσης (Συσχετίσεις, Παραγοντικές, Παλινδρόμησης, κατά Συστάδες, Νευρωνικών Δικτύων, Καμπυλών-ROC, Πιθανοτήτων), τα αποτελέσματα επιβεβαίωσαν τις προσδοκίες. Βρέθηκε ότι όλα ανεξαιρέτως τα Πρόσωπα είναι και δηλώνουν υγιή με βάση σημασίες που προσδίδουν στην και σκοπόσημα που ορίζουν επαρκή για την υγεία τους, καίτοι αυθόρμητα παρεκκλίνουν προς δυσαρμονίες ετεροπροσδιορισμού της, που έτσι δεν αποσοβούν ενδεχόμενη δεινοπάθεια. Προέκυψε επίσης ότι η τελευταία σχηματίζεται συμβατή με τα προφίλ τους, ενόσω τα δημογραφικά τους στοιχεία εμφανίζουν αμελητέας σπουδαιότητας επιδράσεις στην ουσία της φυσιογνωμίας τους. Προεχόντως, εμφαίνεται ότι οι διαφορικές δομικές διαρθρώσεις εαυτότητάς τους, όπως καταρτίζουν τη μοναδικότητά τους, ευσταθούν καλώς ως προβλεπτικά πρότυπα. Η Συζήτηση προωθεί πορίσματα ιδίως από συσχετίσεων, όπως απευθείας συναποτελούν βιώσιμες προτάσεις για αξιοποίηση προς όφελος των Προσώπων και των αρωγών τους, προσβλέποντας σε συνέχεια της διαδρομής που σηματοδοτεί η εδώ έρευνα, ανανεωμένη ψυχοεκπαίδευση και ανάλογες θεραπευτικές πρωτοβουλίες. Σχολιάζει ως προσόν της, τελικώς, τα άχροα αποτελέσματα που προέκυψαν μεταξύ δημογραφικών στοιχείων και ποιοτικών της μεταβλητών. Αναγνωρίζει αδυναμίες που διέπουν το ποιόν και το ποσόν της, με διαλεκτική διάθεση ως προς δυνατότητες προσεχούς διόρθωσής τους, και ολοκληρώνεται ενδυναμωμένη από την επιβεβαίωση των προσδοκιών της, διατεινόμενη ότι μέθοδος, ευρήματα και πορίσματά της τείνουν πράγματι να προσφέρουν χρήσιμα εργαλεία στη νέα προοπτική που διανοίγει, με-και-για πρόσβαση στα Πρόσωπα, ομιλώντας στην εαυτοκεντρική, εγγενή τους γλώσσα. Λέξεις-κλειδιά: Εαυτός, Έλεγχος, Έλξη, Ευθύνη, Διαφορικές Δομικές Διαρθρώσεις, Πολυπαραμετρικότητα, Σύνολη Υγεία, Αυτοδιαχείριση, Αρωγή, Ψυχοεκπαίδευση.